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Updated: Nov 19, 2025

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Published on: February 10, 2013
Bezold-Jarisch reflex-mediated asystole during dobutamine stress testing: a case report
Nimrah Hossain1, Naseem Hossain2, Mohammed Al-Sadawi2
1Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA.
Background:
The Bezold-Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography.
Case Summary:
We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20 μg/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal.
Discussion:
This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.
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